Fibroids and pregnancy - all the nuances of labor and pregnancy. What is interstitial submucous uterine fibroid? Multiple uterine fibroids and pregnancy

One of the difficult problems of modern obstetrics is the combination of uterine fibroids and pregnancy. In many patients this condition proceeds normally. However, there is always a risk of developing severe complications that can lead to the loss of not only the pregnancy itself, but also the uterus. The reasons for such complications:

the tumor itself (large size of the node, disruption of its nutrition, unfavorable location, scars after myomectomy);
the factors that caused it (hormone imbalance, endometrial trauma, adnexitis and others).

Women are often interested in the question: is it possible to get pregnant with uterine fibroids? The likelihood of pregnancy depends on the location of the tumor foci, their number and size. With small accumulations of cells located deep in the uterine wall, the onset and development of pregnancy can proceed normally. With large nodes, especially those located in the isthmus, at the mouths of the fallopian tubes, which grow quickly, the possibility of becoming pregnant is low. If the embryo is formed, there is a high risk of complications and pathology of the fetus.

Changes in the uterus during pregnancy

The presence of uterine fibroids and the fact of pregnancy influence each other. During pregnancy, myomatous cells change, and the function of the placenta is disrupted.

There is a disruption in the blood supply and nutrition of the tumor nodes. Especially often such changes occur in small single lesions located with outside myometrium, that is, subperitoneal. Subserous fibroids can be complicated by torsion of the tumor stalk. The risk of this condition increases with intense physical activity, hypertonicity of the uterus, gestosis of pregnancy with edema and increased blood pressure.

In case of hemorrhage into a myomatous node or its rapid growth, outstripping the growth of capillaries, degeneration of fibroid tissue occurs.

The placenta is most often affected when it is located above a large myomatous lesion. In this case, the structure of the blood vessels of the placenta is disrupted, they become short, defective, and often thrombose. The chorionic villi are underdeveloped and dystrophic. As a result, placental insufficiency occurs.

The most pronounced circulatory disorders in the placenta are later before childbirth. Therefore, such women are recommended to have a planned caesarean section at 38-39 weeks of gestation.

Examination of pregnant women

First, the pregnant woman is questioned, specifying the number of pregnancies and births, the presence of abortions, uterine surgeries and other manipulations. Find out hereditary predisposition to this disease. The presence of undeveloped and induced pregnancies, miscarriages, and the birth of non-viable children is noted.

A general clinical examination evaluates your general health. Special attention pay attention to conditions such as diabetes, pyelonephritis, hypertension.

A gynecological examination is designed to identify the location and size of myomatous nodes. It is necessary to clarify the obtained data using ultrasound examination. Ultrasound helps determine the number, location and growth pattern of tumor foci, their size, structure and location in relation to the placenta. In addition, with its help, the doctor monitors the development of the fetus.

Risk factors for pregnancy pathology with uterine fibroids

Factors that increase the likelihood of developing pathology:

burdened obstetric history (previous birth of a non-viable child, infertility);
scars on the uterus after any operations;
concomitant diseases, in particular varicose veins pelvic veins;
features of the location of the nodes - intermuscular, cervical, isthmus, in the lower segment, with centripetal growth);
the size of the largest lesion is more than 8 cm;
pronounced myomatous changes, that is, the presence of five or more nodes;
centripetal (inward-directed) tumor growth or submucosal node, leading to deformation of the organ cavity;
location of the placenta above the node;
swelling, necrosis, degeneration of the myomatous focus;
age over 30-35 years, when the ability of myometrial cells to stretch and contract decreases.

So, there is a low probability of complications in young women without scars on the uterus and concomitant diseases, which have up to 5 nodes up to 8 cm in size. These formations are located in the body and bottom of the organ and do not cause discomfort in a woman and grow towards the peritoneum, that is, outward. The placenta is located away from the node. Small uterine fibroids usually do not progress during pregnancy. Fetal development usually proceeds without complications. Sometimes, as the embryo grows, the myomatous nodes shift to the side, towards the peritoneum, or vice versa, closer to the uterine cavity, deforming it.

In other cases, the pregnant woman belongs to the high-risk group. She may be offered termination of pregnancy.

Complications of pregnancy due to fibroids

Patients at high risk may develop specific and nonspecific complications.

Specific:

impaired blood supply to myomatous nodes;
isthmic-cervical insufficiency as a result of the cervical-isthmus location of the tumor;
rapid growth of the tumor (proliferating fibroids);
fetoplacental insufficiency;
pelvic vein thrombosis;
rupture along the scar after myomectomy.

Non-specific:

miscarriage or premature birth;
premature;
ingrowth of chorionic villi;
gestosis;
anemia.

The frequency of miscarriages in women with high risk up to 60%, premature birth occurs in a quarter of such patients. If there is a threat of miscarriage, generally accepted treatment regimens are used, including antispasmodics, antiplatelet agents, vitamins, and Duphaston. Semi-bed rest or bed rest, it is recommended to avoid sexual activity and physical activity.

In case of isthmic-cervical insufficiency, sutures are not placed on the neck to avoid damage to myomatous nodes. Bed rest and administration of Ginipral are used.

If the tumor grows rapidly, antiplatelet agents (Curantil) are prescribed to improve the nutrition of the node. In more severe cases, antispasmodics, tocolytics, fresh frozen plasma, and hepatoprotectors are indicated.

To prevent placental insufficiency in the high-risk group, Aspirin, Curantil, multivitamins and folic acid are used. Treatment of placental insufficiency is carried out in a hospital. Reopoliglyukin, fresh frozen plasma, Trental, Actovegin, Eufillin, Magne B6, Curantil are prescribed.

Uterine fibroids during pregnancy can be complicated by malnutrition of the node. Pain appears in the lower abdomen of different nature, body temperature rises, the woman’s general condition worsens. There is a threat of termination of pregnancy. Treatment includes antispasmodic, antibacterial, and desensitizing agents. If there is no effect of therapy, the node is removed (myomectomy) within 3-5 days. This is only possible in the case of subserous fibroids.

Cases when you have to resort to surgery:

necrosis (purulent melting) of the node;
peritonitis;
malignant transformation of fibroids;
infringement of the uterus in the pelvic cavity;
rupture of the node capsule.

Pregnancy management tactics

the patient's persistent desire;
treatment after 24 weeks when a viable fetus is present;
long-term infertility when the child is long-awaited;
the opportunity to terminate a pregnancy only through small caesarean section.

Indications for termination of pregnancy with fibroids:

suspicion of malignancy in any organ;
submucous uterine fibroids;
node necrosis;
location of the lesion in the cervix with the development of isthmic-cervical insufficiency, intrauterine infection of the fetus, bleeding, miscarriage;
the size of neoplasms is more than 15 cm or there are a large number of them;
woman's age over 45 years in combination with risk factors;
severe concomitant diseases.

Childbirth and postpartum period

A pregnant woman is hospitalized at 37-38 weeks. They examine blood clotting indicators, the condition of the placenta and fetus, and determine the maturity of the cervix. Taking into account risk factors, delivery tactics are chosen. Women at low risk may have a vaginal birth. In more difficult cases Caesarean section is preferable. If you try to conduct childbirth in such patients naturally, you can call severe complications– placental abruption and uterine rupture.

Caesarean section is performed routinely in the following cases:

nodes located in lower parts, preventing the advancement of the fetus;
multiple or very large nodes;
scar on the uterus;
malnutrition of the nodes, which can intensify during childbirth and lead to necrosis;
breech presentation of the fetus;
suspicion of necrosis or malignant degeneration;
accompanying illnesses.

Cases when the uterus is removed during a caesarean section:

multiple lesions in women over 40 years of age;
necrosis of the node in the thickness of the myometrium;
tumor recurrence after myomectomy;
submucosal or interligamentous nodes, centripetal growth and other unfavorable location features.

After pregnancy, most women's fibroid growth slows or stops. This is facilitated by breast-feeding and the use of hormonal contraception. Prevents the growth of fibroids repeat pregnancy and childbirth two to three years later.

Uterine fibroids today are a fairly common phenomenon, and the frequency of its diagnosis has especially increased during pregnancy. It is completely logical that a woman childbearing age Increasingly, questions are arising regarding the possibility of becoming pregnant in the presence of uterine fibroids or after its removal, about its effect on the course of pregnancy and methods of its treatment during pregnancy.

The effect of fibroids on pregnancy.
It must be said right away that fibroids are a benign tumor that occurs against the background of the proliferation of muscle fibers of the walls of the uterus. Let me clarify right away that any tumor formation in the uterine cavity sooner or later leads to its enlargement. The growth of fibroids can be very rapid, but it may not be observed at all, and for quite a long time. During gestation, the uterus also increases in size corresponding to a particular period. This is why uterine enlargement is initially associated with pregnancy, and only the results of an ultrasound can make an accurate diagnosis.

Myoma really complicates the process of conception, since its size puts pressure on the fallopian tubes, putting obstacles to the movement of sperm, and also disrupt ovulation. As such, it is not a cause of infertility, but its removal significantly increases the chances of conceiving a baby, unless, of course, its size does not exceed twelve weeks of pregnancy. With larger sizes, the tumor leads to deformation of the uterine cavity, resulting in surgical intervention save reproductive function quite difficult, since the removal of large fibroids is often accompanied by severe bleeding, and in some cases, specialists are forced to simply remove the uterus.

In the first months of pregnancy, complications may arise from fibroids; this occurs mainly when the tumor is close to the placenta. In this case, the size of the tumor is no less important. With small myomatous nodes, pregnancy proceeds without complications, and the tumor itself does not manifest itself in any way.

Fibroids in the second and third trimester of pregnancy increase the risk of miscarriage, as well as premature birth. This happens as a result of the fact that myomatous nodes leave less and less free space for the fetus, in addition, they stimulate contractile activity uterus. In this situation, the location of the fibroid and its distance from the placenta (whether there is contact) also plays an important role.

Large tumors may affect normal growth and fetal development. There are often cases of children being born with low weight, with an altered shape of the skull, curvature of the neck, etc.

Most experts agree that uterine fibroids affect the birth process, significantly delaying it. Also, if it is present, specialists more often decide to perform a cesarean section. In this situation, it is not the fibroid itself, as such, that prevents childbirth, but significant size myomatous nodes in combination with pathologies of the position and presentation of the fetus (transverse, pelvic and facial presentation). Sometimes, if the C-section incision matches the location of the fibroid, the doctor may remove it.

It should be noted that in pregnant women with fibroids, placental abruption often occurs, especially when the tumor is located retroplacentally (behind the placenta). During birth process doctors take this feature of the tumor into account.

In the postpartum period, fibroids can also cause complications, both immediately (bleeding against the background of low uterine tone) and after a fairly long period of time ( infectious diseases, the uterus does not reach its original size).

Planning pregnancy in the presence of uterine fibroids.
At the conception planning stage, it is necessary to take into account facts such as the location of the fibroid, its growth tendency, and the size of the nodes. If the location of the nodes leads to deformation of the uterine cavity, then it is basically impossible to get pregnant, since spermatozoa, without reaching fallopian tubes, settle on their surface without ever meeting the egg. In this case, the nodes must be removed.

If the nodes are small and located in the thickness of the uterine wall or outside, that is, there is no deformation of the cavity, then the probability of pregnancy is quite high. It should only be said that in the event of fertilization, a woman may have problems associated with bearing a fetus.

If a woman has a myomatous node on a thin stalk, then there is a high risk of torsion during pregnancy, and this, as a rule, leads to surgical intervention and often to miscarriage. In this situation, at the stage of pregnancy planning, it is urgently recommended to remove such nodes.

It is also important to note that if, according to ultrasound data, it was established that the tumor is predisposed to rapid growth (doubling in size within six months), then planning pregnancy is prohibited. This is due to the high risk of fibroid enlargement during pregnancy, which provokes malnutrition in the node, and this is fraught with miscarriage. At the stage of planning conception, such a tumor must also be removed in advance.

In the case of large uterine fibroids (4 cm in diameter and above), it is also worth postponing conception, since, firstly, this is unlikely (against the background of endometrial pathology), and if it happens, it is fraught with miscarriage, since the probability of miscarriages and malnutrition of the fetus, which will lead to surgery. Nodes are also subject to removal at the planning stage of the child.

Growth of fibroids during pregnancy.
No doctor can reliably answer how a tumor will behave during pregnancy (if it is present before conception). Plays a big role here genetic factor. In most cases, the growth of fibroids is observed in the first two trimesters of pregnancy, and in the third, on the contrary, their decrease is noted. As a rule, during gestation, fibroids are reduced in size by an average of thirty-five percent, but there is still a small percentage of cases where fibroids double during gestation, but this practically does not complicate or complicate pregnancy. However, destruction or degeneration of fibroids can contribute to various complications. This process is combined with tissue necrosis of destroyed fibroids, bleeding, formation of cysts, etc. This phenomenon can occur, frankly, at any stage of pregnancy and after delivery. In this case, the location of the fibroids matters.

Why fibroids are destroyed during pregnancy is not completely known. This can be facilitated by hormonal (increased progesterone levels), vascular and mechanical changes (impaired blood supply to the tumor due to thrombosis). This process is accompanied by pain in the area where the node is located, an increase in uterine tone, an increase in body temperature, an increase in the level of leukocytes in the blood and the erythrocyte sedimentation rate. Degeneration of fibroids is diagnosed using ultrasound. Initially, the patient is recommended to rest in bed and prescribed analgesics; if severe symptoms persist, she is hospitalized for further inpatient treatment.

Surgical treatment is prescribed in exceptional cases if there is absolute readings(severe fever, leukocytosis, deterioration general condition, acute abdominal pain, uterine bleeding). It is often possible to save a pregnancy with surgical intervention.

I note that fibroids that grew in the first months of pregnancy may not make themselves known at all after childbirth. After childbirth, as the uterus returns to the initial state, the location of myomatous nodes may change.

Treatment of fibroids during pregnancy.
Initially, fibroid therapy is conservative and aimed at stopping growth benign education. Methods in each specific case depend individual characteristics tumor and the causes of its development. During pregnancy Iron-deficiency anemia in a pregnant woman it can become a factor provoking the growth of fibroids. It is this fact that serves as one of the reasons for the constant study of a woman’s blood during this period.

Therapeutic and preventive measures for uterine fibroids are taking iron supplements, ascorbic acid and folic acid, B vitamins, diet with a predominance of protein foods. Vitamins E and A are also recommended, which have a beneficial effect on the neuroendocrine system and reduce the sensitivity of the genital organs to estrogen.

If lipid metabolism is disturbed in a pregnant woman with fibroids, her diet is adjusted: the consumption of carbohydrate foods is severely limited, any animal fats are excluded (they are replaced with vegetable fats), and more freshly squeezed juices from vegetables and fruits are included in the diet.

After delivery, the woman is prescribed hormonal agents with progesterone, which reduces the ability of cells to divide, preventing tumor growth. If it is impossible or unsuccessful attempts to stop the growth of fibroids, a decision is made to surgical treatment (conservative myomectomy– removal of nodes while preserving the uterus).

Laparoscopy technique (an operation performed using an endoscope and instruments, under the control of a video camera installed in abdominal cavity) significantly reduces the risk of developing adhesions in the pelvis, which in the future helps maintain the patency of the fallopian tubes, and this is one of the main factors in pregnancy. Treatment method using laparotomy ( abdominal surgery, everything is done by the surgeon manually) is associated with a high risk of the formation of adhesions, and their formation can occur both in the pelvis and in the abdominal cavity. In the future, this leads to infertility, and sometimes to complications from digestive system(for example, adhesive intestinal obstruction). However, the large size of the nodes during laparoscopy does not allow suturing the uterus as required, which is due to the peculiarities of the technique, the angle of the abdominal instruments, and some technical issues.

As a result, laparoscopy is performed for women planning a pregnancy if the size of the nodes does not exceed 5-6 cm. In this case, suturing the uterus requires the skill and experience of a surgeon. To remove large nodes, there are new technologies for suturing the uterus, but this significantly increases the risk of uterine rupture along the scar.

If the nodes exceed 9-10 cm in diameter, the risk of uterine rupture along the scar is significantly higher than the risk of formation of adhesions due to laparotomy. Therefore, it is recommended to abandon laparoscopy and open the abdominal cavity to excise the tumor.

After removal of uterine fibroids, regardless of the technique used, conception can be planned only after eight to twelve months, it all depends on the size of the removed tumor.

It should be noted that after removal of fibroids, a woman’s labor can be managed in a natural way, if the removed nodes were no more than four centimeters in diameter, if there are no complications during pregnancy and after childbirth, if the uterine scar is in satisfactory condition. The woman’s age also plays a huge role. In other cases, a caesarean section is indicated.

Multiple fibroids uterus.
It also happens that several myomatous nodes are formed in the uterus at once, and of different sizes. Planning a pregnancy in this situation is very difficult, since removal of such formations can lead to the fact that there is no healthy tissue left on the uterus. In such situations, doctors prescribe the removal of only those nodes that interfere with the attachment of the embryo, tend to grow, interfere with the gestation of the fetus and can cause complications, etc. After delivery, you can begin excision of the remaining nodes, or doctors can do this during a cesarean section.

Submucosal fibroid The uterus is a benign tumor. It develops in the muscle tissue of the uterus under the mucous membrane, the growth of the formation is directed into the cavity of the organ.

When submucous uterine fibroids are diagnosed, what it is is a question that worries a woman. According to ICD 10, this tumor is benign in nature.

Unlike other types of fibroids, submucous fibroids are characterized by a rapid increase in size, severe symptoms and quite frequent transition to a malignant form.

According to statistics, submucosal fibroids account for about 30 percent of the total number of uterine tumors. It develops more often in women of reproductive age.

The exact reasons for the development of pathology cannot be named, but the most common culprit is a hormonal imbalance.

Submucous uterine fibroids: symptoms and signs

Myoma with a submucous location of the node is often on initial stages develops hidden. And only when acquiring large sizes does a woman experience the following:

, which lasts longer than usual;
during menstruation;
which radiates to the lower back and lower abdomen;
general weakness and malaise;
inability to conceive when planning pregnancy;
increase in abdominal circumference with large sizes tumors.

Myoma with submucous growth of a small node gives practically no symptoms.

Is this disease scary? A sharp increase in body temperature with acute pain in the lower abdomen may indicate a rupture or twisting of the myomatous node. In this case, emergency medical attention is required.

Pregnancy

- concepts that are quite compatible with small sizes of education. The answer to the question, in the presence of a submucosal tumor, is positive, again with a small size of the latter. In this case, the formation does not interfere with the passage of male germ cells into the uterine cavity.

But if a submucous tumor quickly increases in size, then it gradually fills the uterine cavity. Once conception occurs, it will interfere with the growth of the embryo. Why is this pathology dangerous? First of all, a miscarriage, which occurs most often after 11 weeks.

Causes

Submucous uterine fibroids, which must be treated immediately, can develop in women for the following reasons:

diseases that cause hormonal imbalance;
inflammatory and infectious diseases of the reproductive system;
long-term use of hormonal contraception;
a sharp decrease or increase in body weight;
constant stressful situations;
hereditary factor;
absence of childbirth and lactation before the age of 30.

The development of a submucosal tumor can be caused by one reason or a combination of several. Reveal exact reason Only a doctor can do this based on examination data.

Diagnostics

Diagnosis of a formation in the uterus in most cases occurs during an examination by a gynecologist.

Ultrasound. The study is carried out transabdominal or transvaginally.
Hysterosonography or intrauterine echography. It is performed if a woman has heavy uterine bleeding.
Three-dimensional echography. This technique makes it possible to obtain the most objective information.
Dopplerography. Allows you to identify structural changes in the tissues of the uterus and predict the further growth of the myomatous node.

After diagnosing and obtaining data, the doctor will choose the necessary treatment tactics.

Treatment methods

Some time ago, surgery for large submucous uterine fibroids was the only treatment option. In most cases, when the tumor was removed, the uterus was also removed.

Today it is used not only surgical treatment, but also conservative.

If submucous uterine fibroids are diagnosed, treatment without surgery is possible under the following conditions:

small size of submucosal fibroids - no more than 12 weeks;
lack of rapid growth of the node;
the patient has children and desires to have them in the future.

primary goal conservative therapy- preservation reproductive function and stopping the growth of myomatous nodes.

For this purpose, hormonal treatment is prescribed:

Antigonadotropins. Used for small tumor sizes. The goal is to stop the growth of fibroids. It is also prescribed at the stage of preparation for surgery. Effective drug- Gestrinone.
GnRT agonists. The drugs stop the growth of nodes and also help reduce their size. This type of therapy eliminates pain and also stops bleeding. Prescribed drugs - Buserelin, Zoladex, Triptorelin, Goserelin. Reviews after such therapy are usually positive.

At the same time, the doctor prescribes symptomatic therapy:

painkillers;
sedatives;
anti-anemia drugs;
vitamin complexes.

When passing conservative treatment, a woman should visit her doctor at least twice a year.

Surgical intervention

Depending on the diagnostic data, the patient may be offered surgery, such as the only way therapy. You need to understand that surgery is often the most effective technique in the presence of submucosal fibroids.

Refusal to undergo surgery at the initial stages of tumor development may lead to the need for a hysterectomy at a later stage, that is, not only removal of the tumor, but also.

If there is submucous uterine fibroid, the size for surgery is determined by the attending doctor. Indications for use surgical intervention:

large size of formation - more than 12 weeks;
rapid increase in the size of nodes;
severe pain;
heavy bleeding from the uterus.

At prompt removal submucosal tumors are used the following techniques:

. The goal is to stop feeding the tumor and its gradual resorption. To do this, a medicinal substance is administered by inserting a catheter.
Laparoscopic myomectomy. The tumor is removed using a laparoscope.
Laparotomy myomectomy. A full-fledged operation in which the removal of the myomatous node is carried out by cutting the peritoneal tissue.
Hysteroresectoscopy. Removal of the node using a hysteroscope.
Hysterectomy. With this type of operation, not only the myomatous node is removed, but also the uterus.

ethnoscience

Question about the treatment of submucous uterine fibroids folk remedies interests those women who are categorically against traditional treatment.

Opinion about greater efficiency herbal infusions Unlike medications not always true.

Upon admission herbal remedies A doctor's consultation is required. At the same time, it is necessary to understand possible consequences refusal of therapy prescribed by the doctor.

Every woman faced with a pathology such as uterine fibroids should understand that even after successful surgical intervention there is always a risk of relapse. Therefore, it is so important to periodically visit a gynecologist for examination and do an ultrasound. Such measures make it possible to timely find out about re-development education and minimize the risk of possible complications.

Video about treatment

Article outline

Many women who are planning their pregnancy often face various obstacles in the form of benign tumors of the uterine muscles. If fibroids are detected and pregnancy has already been going on for several months, then there is no need to panic. Sufficient quantity examples of how a woman learned about the presence of a tumor during pregnancy, but her child was born healthy. For the normal course of this period, it is necessary to know the danger of fibroids for the uterine cavity.

Expectant mothers begin to worry when they hear the diagnosis of uterine fibroids during pregnancy. Is it dangerous to have uterine fibroids when they are discovered while carrying a baby? This question still remains open. But, despite this, doctors know how to act when such a diagnosis is discovered.

What is uterine fibroid and why does it occur?

This formation is considered benign; it is a tumor that grows on the muscles of the uterus. Experts have not yet been able to give specific answers as to why this is happening. But there are suggestions that this may be increased hormonal stimulation and increased secretion of estrogen. In other words, a tumor forms due to low level progesterone in the body and increases due to the excess balance of estrogen.

But if no hormonal imbalance is detected in the blood, this does not mean that a tumor cannot form. The level of estrogen in the uterus may increase slightly and not be reflected in a blood test. In almost all cases, the formation consists of several nodes in various sizes of seals. This type of tumor is considered common, but expectant mother it is extremely undesirable.

Causes

This disease occurs as a result of hormone imbalance. The amount of estrogen increases, which contributes to rapid cell division and the formation of unwanted nodes. Nodes can grow in different places on the uterus in multiple quantities. If a tumor is detected and treated in time, then it does not pose any danger.

Reasons for the rapid production of estrogen by the ovaries:

genetics (if women had such a disease, then it is difficult for the next generation of women to avoid it);
infections that inflame the genitals;
intentional termination of pregnancy;
cyst on the ovaries;
birth control pills;
excess weight;
chemotherapy.

Uterine fibroids often cause infertility. But there are cases when pregnancy is still possible. Practice suggests that this disease affects every body differently. Doctors cannot fully answer why some women give birth when fibroids form in the uterus, while others are unable to conceive a child with this benign multiple formation.

Symptoms

A formation on the uterus is accompanied by the following symptoms:

the menstrual cycle is very painful;
women very often feel slight pressure in the lower abdomen;
abdominal pain intensifies and has a pulling character;
sexual intercourse often becomes painful for a woman;
the bladder often makes you want to go to the toilet;
the functioning of the gastrointestinal tract is disrupted;
belly growth.

To be able to give birth to a baby, you need to contact a specialist for examination at the first sign of these symptoms. He will order an ultrasound to detect fibroids on muscle layer uterus. Ultrasound examination will help to detect tumor formations in time. Also, using this procedure, the doctor will find out:

the number of nodes that have formed on the uterus;
condition of myomatous nodes;
their place of growth;
exact size of fibroids;
exact location of lesions;
structure of tumors.

These characteristics are necessary to determine the answer to the question - whether a woman has the opportunity to give birth to a child. Conception can occur if nothing blocks the entry of sperm into the uterus and does not disrupt the ovulation process. For successful pregnancy the cervix should not be blocked by this tumor formation. As you can see, there is a possibility of pregnancy with this diagnosis.

Diagnostics

At the very beginning of the diagnosis, doctors ask the woman a number of questions. They find out how many times the woman was pregnant and how many times she terminated the pregnancy. Also, specialists need to find out whether there have been uterine surgeries or miscarriages. One of the questions may be about the birth of a non-living child. After clarification of all the nuances, the woman is sent for a study in which various methods diagnostics

General clinical examinations and taking tests. Doctors find out the main aspects of this disease. Diabetics and hypertensive patients are examined very carefully, because these diseases have big influence for the entire treatment process. Besides general studies, the woman goes to the gynecologist.

The gynecologist must clarify through research all the sizes of the formed nodes and changes in the fibroids. Also, the exact location of fibroids. In addition, with the help of an ultrasound machine, a specialist monitors the development of the fetus if a pregnant woman is diagnosed. Ultrasound also determines where the tumors are located.

Treatment

At the very beginning of treatment for a woman who has been diagnosed with a tumor, doctors try to stop further growth of the tumor. All ways to stop development benign tumor depend on the individual characteristics and structure of the fibroid. Also, the reason why the disease was diagnosed plays an important role. Pregnant women often feel iron deficiency in the body, and this can lead to tumor growth. Therefore, due to this factor, during pregnancy it is necessary to constantly take a blood test.

Prevention

Prevention involves taking iron, ascorbic acid And various vitamins. Proper nutrition, which includes food with big amount squirrel. Carbohydrates should be limited, and you should also stop eating animal fats. Fresh juices, vegetables and fruits have a beneficial effect on disease prevention. After giving birth by cesarean section, a woman may be prescribed a drug with progesterone. Thus, the process of cell division in the uterus is significantly reduced. The tumor does not grow under such conditions.

How fibroids affect pregnancy

It's no secret that such education has negative character during pregnancy. It can cause a miscarriage due to a lack of placenta, because the fetus must be surrounded by the placenta. Due to fibroids, the baby may receive little oxygen and all nutrients. The consequences may also cause heavy bleeding due to placental abruption. The worst thing is that all these processes can happen both in the early stages of pregnancy and recent months. Therefore, uterine fibroids have a negative effect on pregnancy.

But if uterine fibroids are detected, you should not immediately terminate the pregnancy. After all, this disease and pregnancy are compatible. You just need to constantly be examined by a specialist. There are many examples where women carried healthy child, while the pregnancy period proceeded absolutely calmly. But it’s better not to take risks, because the child may be born with a small weight or a deformed body. Bad influence fibroids in pregnancy cannot be ruled out at all, even despite many successful cases.

After 40 years, pregnancy is more difficult because at this age hormonal disbalance It has huge probability. Also, the rapid growth of fibroids can significantly outpace the capillaries, which causes bleeding. If no disturbances were observed over the course of 12 weeks, this does not mean that after 20 weeks the same result will occur. The first trimester can pass without any symptoms. But complications can appear at any time. Great chance the fact that in the later stages blood circulation will be impaired because myomatous nodes grow. Therefore, it is recommended to perform a caesarean section when the pregnancy is 39 weeks.

Nowadays, most women give birth after 30. At this age, hormonal imbalances begin to progress. Therefore, before conception, it is necessary for doctors to discover the location and size of the formation. If they reach 4 cm or 5 cm, then pregnancy is possible. But if the fibroid is 7 cm or 8 cm, then this significantly complicates the process of treatment and pregnancy.

How does the disease manifest itself in pregnant women?

A pregnant woman can have many symptoms. When the baby is pregnant, the tumor can disrupt the placenta and its functions. A woman may have a stomach ache. These pains in the lower abdomen are caused by poor circulation in the nodes. Also, there is an increased arterial pressure. A benign tumor can be easily recognized using echo signs of ultrasound examination.

Conception during illness

When a woman plans to conceive a baby, she needs to take into account all the characteristics of the tumor. It is important to know how it is located and where. Also, the size of the nodes and their predisposition to growth play an important role. If the uterus is deformed due to formation, then conception is impossible. In this case, it is necessary to remove the nodes. When planning pregnancy, fibroids should be carefully examined.

If the nodes are small and do not affect the uterus, then the likelihood of pregnancy becomes high. But during pregnancy, problems can arise. A woman may not be able to bear a child. Miscarriage or termination of pregnancy is highly likely.

Can a doctor remove fibroids during a caesarean section?

Removal of fibroids by a doctor during a cesarean section is possible:

in case of single education;
abdominal tumor, which has a stalk;
if there are structural changes in the tumor;
large intermuscular formation.

But it happens that after a cesarean section, it is necessary to completely remove the uterus. This is necessary for women over forty years of age. Also, with necrosis of fibroids and recurrence of tumors. If during a cesarean section it was possible to remove the formation, then the woman can safely plan another conception of a child.

Natural birth or caesarean section

For each woman with a tumor, the choice of childbirth is individual. Natural childbirth can take place in the absence of contraindications. For example, the formation does not grow and will not interfere with the birth process. For such births, only pain medication is used. But often the doctor recommends a cesarean section to his patient. During a caesarean section, the fibroids can be removed by a doctor.

Caesarean section is necessary:

if the tumor is located low;
many nodes;
if there is a scar on the uterus after surgery;
the blood circulation of the tumor is impaired.

Contraindications

The growth of fibroids while carrying a child can lead to many complications. The development of all kinds of pathologies and diseases sometimes has to be stopped by emergency birth or termination of pregnancy. Therefore, pregnancy must be taken very seriously. Constant examination by specialists is necessary to avoid unpleasant unexpected situations.

Contraindicated for this disease gynecological massage. Also, the lower abdomen should not be allowed to warm up in any way. That is, a bathhouse, solarium, sauna, etc. are contraindicated. Do not lift weights over 3 kg and drink a lot of water before bed. The latter can lead to swelling of the uterus.

Postpartum period

It is worth noting that tumors after childbirth may stop growing and developing. The uterus returns to its original position, and accordingly, fibroids and nodes also change. Uterine leiomyoma is found in almost every fifth woman, so the process of bearing a child and postpartum period may be complicated by various processes.

Multiple uterine fibroids and pregnancy

In the uterus, fibroids often form with many nodes. After removing all the nodes, there may be no healthy tissue left on the uterus, so planning conception and pregnancy may be accompanied by difficulties. But doctors can remove precisely the nodes that interfere with the development of the fetus, which will lead to various complications. Pregnancy with fibroids can proceed smoothly after removal of such nodes. And after the birth, the doctor will remove the remaining nodes that have formed.

Forecast

Pregnancy with a tumor can proceed calmly. But a tumor can reveal itself at a later stage. This will lead to premature birth or the need for a caesarean section. Also, a miscarriage may occur. Therefore, when planning a pregnancy with this disease, you need to think about all the consequences.

Complications

Why fibroids are dangerous:

insufficient power supply to nodes;
neoplasms begin to grow rapidly;
placental insufficiency;
vein thrombosis;
miscarriage;
anemia.

Myoma during pregnancy threatens miscarriage. The risk is quite high. The percentage reaches the sixty mark. 25% of women give birth prematurely. To prevent the threat, patients take vitamins and special means. Doctors recommend staying in bed and limiting yourself to physical activity to prevent the occurrence of various complications.

Surgery to remove uterine fibroids during pregnancy

The surgical method is used to treat fibroids. Laparoscopy is an operation that is performed necessary tool and a camera for recording video in the abdominal cavity. This operation prevents the formation of adhesions and increases the patency of the tubes, so that a woman can become pregnant. This technique is safer than, for example, laparotomy.

The surgery to remove fibroids, called laparotomy, involves a manual process that may carry the risk of adhesions. This can lead to consequences such as infertility and even intestinal obstruction. But with the first type of operation, if the fibroid nodes are large, it will not be possible to stitch the uterus. This is solely due to the use of specific technology.

Therefore, women undergo laparoscopy and remove fibroids if the nodes are small - no more than six centimeters. An experienced surgeon is able to suture the uterus under such conditions. To sutured the uterus, which had large nodes, there is latest technology, but it also has some nuances. There is a risk that the uterine scar will simply rupture. Removing fibroids during pregnancy is not advisable because there is a risk of miscarriage. Often, fibroids are removed during childbirth during a cesarean section.

But is it necessary to remove fibroids before pregnancy? Yes, because then the pregnancy can proceed in the most normal way, without any intervention. But this is provided that the nodes were small size. Also, before planning to conceive, it is necessary to undergo gynecological examination to make sure good condition scar. The age of the pregnant woman also plays an important role in this matter.

Treatment of infertility with fibroids

To cure infertility when a tumor is detected, surgery is necessary. If the size of the fibroids is large, then it can interfere with the process of conception. After its removal, there is a chance to conceive a child. But if the size was large, which led to deformation of the uterus, then perhaps the fibroids will be removed along with the uterus itself. It is necessary to detect the tumor in time so as not to lead to such consequences.

How pregnancy affects fibroids

Doctors cannot guarantee exactly how the formation on the uterus will change during pregnancy. We have not yet found out exactly why the formation decreases during pregnancy, which happens in most cases. But there is a small percentage that the tumor can almost double in size. However, it does not always interfere with pregnancy and childbirth. Perhaps progesterone increases and fibroid development decreases. But scientists cannot fully answer this question.

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The appearance of symptoms of this pathology causes panic in women. When fibroids are detected in the uterus and pregnancy has already occurred, this may have dangerous consequences for the expectant mother and fetus, especially with large tumor sizes. Why a neoplasm develops, what it is, and whether it can become a problem for conception is important for women of childbearing age to know.

What is fibroid

When does it occur in the body? hormonal disorders associated with excess estrogen and progesterone deficiency, in muscle tissue the walls of the uterus are born benign tumor process– fibroids. Its growth provokes abnormal division of cellular structures, which begins asymptomatically. As the process progresses, the following appear:

prolonged menstruation with heavy blood loss;
sharp cramping pain in the lower abdomen, in the lower back;
frequent urination if the node is located on the isthmus of the uterus;
constipation;
increase in abdominal size.

During the period of waiting for a child, neoplasms can develop on any part of the organ and have dangerous consequences. Multiple fibroids are often observed. Based on the location of the tumor, there are:

subserous (subperitoneal) - under the outer cover of the uterine body;
interstitial (intermuscular) - in the thickness of the wall;
submucosal (submucosal) - in the layers under the endometrium.

Is pregnancy possible with uterine fibroids?

It is good if a woman’s tumor is discovered during pregnancy planning. It is advisable to treat or remove the node during this period. Deformation of the uterus by a tumor can affect conception:

prevents sperm from getting to the egg - the lumen of the fallopian tubes narrows;
prevents ovulation;
makes it difficult for the fertilized egg to attach to the walls;
when large in size, it rejects it, causing infertility.

If pregnancy with fibroids does occur, it must be terminated if:

submucous form of the tumor;
suspicion of malignancy;
for sizes greater than 15 cm;
multiple nodes;
degeneration or necrosis of tumor tissue;
severe concomitant pathologies;
woman's age after 45 years;
localization of the node in the cervix, complicated by uterine bleeding;
threats of miscarriage.

How are fibroids diagnosed?

If symptoms of the disease appear, a woman should visit a gynecologist. The tumor is detected by palpation through the anterior abdominal wall. More accurately diagnosed when ultrasound examination, which reveals the location, number of nodes, size, location relative to the placenta. Ultrasound is performed in two ways:

transvaginally - by inserting a sensor through the vagina into the uterine cavity - in the absence of a fetus;
transabdominal - through the anterior wall of the peritoneum.

There are diagnostic methods that are not used when fibroids and pregnancy are diagnosed at the same time. This may pose a risk to the development of the embryo. These include:

hysterography – X-ray examination using a contrast agent;
hysteroscopy - examination of the organ cavity with a special device inserted through the vagina.

Consequences of fibroids during pregnancy

A woman with symptoms of a neoplasm must register to continue her pregnancy. The tumor can cause serious problems, influence the development of the child, the health of the mother. Myoma during pregnancy threatens:

placental insufficiency;
tumor pressure on the fetus;
disruption of the supply of nutrition and oxygen to the embryo;
placental abruption;
premature birth;
spontaneous abortion;
tissue necrosis due to disruption of the blood supply to the tumor;
compression of veins, the appearance of blood clots;
iron deficiency anemia;
rupture of the uterine body.

Myoma during early pregnancy

A woman should be careful in the first trimester, especially if there is hereditary factors. If small nodes are detected, the disease may be asymptomatic. Myoma during early pregnancy is dangerous when it big size. In this situation:

bloody discharge appears;
the risk of frozen pregnancy increases;
there is a possibility of miscarriage if a submucous form of the tumor is observed;
circulatory disorders occur;
contact of fibroids with the placenta causes an increase in uterine tone and miscarriage.

Second and third trimesters of pregnancy

At later stages, a large node leaves little room for the growing fetus. It is dangerous when it is located next to the placenta. This development is fraught with consequences:

risk of premature birth;
the emergence of a threat of termination of pregnancy;
the birth of a low-weight baby;
the likelihood of placental abruption;
deformation of the skull in a newborn.

Pregnancy with small uterine fibroids

Many women who are diagnosed with tumors in the uterus feel well while expecting a child and do not experience any complications. This is due to the small size of the tumor. Problems for the mother and the unborn child appear in cases where:

there are many nodes that deform the uterus;
the tumor is close to the neck;
the placenta is located in the area of the myomatous node.

Pregnancy with large uterine fibroids

When a neoplasm grows to enormous sizes, it can adversely affect the course of pregnancy. Blood circulation in the uterus is disrupted, which can provoke degeneration of fibroids. At the same time, prostaglandins are released from it, causing contraction of the uterine muscles. In such situation:

premature birth occurs;
high probability of miscarriage.

For the development of the fetus, a huge tumor poses no less danger. It takes on most of the blood that supplies the uterus with the embryo, providing oxygen and nutrition. In addition, the tumor puts pressure on growing organs. All this leads to serious problems:

deformations of the skull, neck;
low birth weight of the newborn;
underdevelopment of organs;
fetal death.

Pregnancy management tactics

Women who have symptoms of a tumor in the uterus need to register as soon as possible. The doctor conducts full examination, determines the size of the tumor. If it has large volumes, is poorly located, or many nodes are noted, it is decided important task– terminate or maintain pregnancy. A positive conclusion is accepted in the following cases:

long-term infertility ending in conception;
woman's desires;
more than 24 weeks when the fetus is viable.

If there is a benign tumor in the uterus, it is necessary increased attention gynecologist and woman's health status. Important role plays a role in preventing the destruction of fibroids and uterine tone. Expectant mothers are advised to:

take place regularly ultrasound examination placenta and nodes, when they are located close;
exclude physical activity;
to sleep more;
ensure sexual rest;
avoid stressful situations.

Childbirth with uterine fibroids

When diagnosing myomatous nodes, gynecologists recommend hospitalization at 37-38 weeks in order to prepare for delivery. A woman can give birth to a child naturally through birth canal under certain conditions. This happens in the case:

if the entire period passed without complications;
the fetus developed correctly;
the position of it and the placenta is normal.

A cesarean section may be necessary when subserous uterine fibroids are diagnosed during pregnancy, complicated by tissue necrosis. Indications for surgical obstetrics are:

breech presentation of the fetus;
the presence of a scar on the uterine body;
large tumor size;
presence of complications;
fact of multiple nodes;
low position of the tumor, preventing the opening of the neck.

So as not to arise late complications, doctors can perform the following when performing a cesarean section:

removal of fibroids, if it is single, subserous, pedunculated, or there are secondary structural changes in the neoplasm;
perform a hysterectomy - remove the uterus completely, when the tumor is multiple in nature, localized under the mucous membranes near the vascular bundles, necrosis of muscle tissue, and relapses of tumors are observed.

Treatment of uterine fibroids during pregnancy

To alleviate a woman’s condition and eliminate complications, gynecologists carry out therapeutic measures. Removal of fibroids during pregnancy is an exceptional case when there is a threat to life. For treatment use:

with rapid growth of nodes - antiplatelet agents that improve microcirculation;
for pain relief - No-shpu;
if there is a threat of miscarriage - bed rest, hormonal medications;
in case of uterine hypertonicity – infusion therapy;
vitamin complexes.

How pregnancy and childbirth affect fibroids

Hormonal changes that take place in a woman’s body have different effects on the development of neoplasms while expecting a child. According to experts, childbirth does not affect the tumor - it is removed during a cesarean section or subsequently. While expecting a child, myomatous formations can:

increase in size in the first two trimesters;
remain unchanged;
decrease in the third trimester;
dissolve;
degenerate - collapse with the appearance of edema, necrosis, bleeding.

Pregnancy after uterine fibroids

If an operation to remove a tumor is performed and no complications are observed after it, gynecologists recommend planning conception in a month. A woman must register with early dates, undergo all examinations. After surgery, a scar remains on the uterine wall, which can cause problems:

threat of spontaneous abortion;
pathology of the placenta;
rupture along the seam during fetal growth with bleeding;
the occurrence of hypertension.

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The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.